Endocrine

Question 1

Most common presenting complaint to pediatric endocrinologist

Answer 1

growth disturbances

Question 2

fetal growth dependent on

Answer 2

maternal factors

Question 3

late infancy growth dependent on

Answer 3

GH/IGF-1 axis and thyroid hormone

Question 4

pubertal growth dependent on

Answer 4

sex hormones as well as GH/IGF-1 axis and the thyroid gland

Question 5

define short stature

Answer 5

height less than 3% on growth chart

Question 6

endocrine causes of short stature

Answer 6

growth hormone deficiency or resistance
hypothyroid
diabetes mellitus

Question 7

Decreased growth velocity, delay in skeletal maturation. Short stature (below 5th percentile), grows normally for first year but drops off during the 2nd. Height may be more retarded than weight

Answer 7

growth hormone deficiency

Question 8

most common form of growth hormone deficiency

Answer 8

idiopathic

Question 9

treat GH deficiency

Answer 9

correct underlying disease
replace GH (only for FDA approved conditions

Question 10

what do you worry about with excessive GH secretion (rare)

Answer 10

pituitary adenoma

Question 11

most common cause of hypothyroid in childhood. Most common cause of goiter and thyroiditis

Answer 11

Hashimotos thyroiditis (autoimmune thyroiditis)

Question 12

most common neonatal metabolic disorder

Answer 12

congenital hypothyroid

Question 13

treat hashimoto

Answer 13

levothyroxine (not if euthyroid)

Question 14

who has increased incidence of hashimoto

Answer 14

trisomy 21, turners

Question 15

physical and mental sluggishness, pale, gray, cool mottled skin. Non pitting edema, constipation, large tongue, poor muscle tone, lordosis, bradycardia, hoarse cry or voice, skin dry, coarse, scaly, yellowish. Lateral thinning of eyebrows

Answer 15

hypothyroid

Question 16

most common cause of hyperthyroidism in kids

Answer 16

graves

Question 17

nervousness, emotional lability, hyperactivity, weight loss. Insomnia, personality changes, diarrhea ,palpitations, heat intolerance,tremor, increased sweating

Answer 17

hyperthyroid (graves)

Question 18

labs for graves

Answer 18

TSH low

FT4, T3, T4 elevated

Question 19

labs for hashimoto

Answer 19

T3, T4, and FT4 decreased. TSH elevated

Question 20

treat hyperthyroid

Answer 20

beta blocker, antithyroid meds (PTU, methimazole)

Question 21

this is more common in girls. Younger than 8 years old

Answer 21

precocious puberty (central idiopathic precocity)

Question 22

central precocious puberty

Answer 22

CNS abnormality (tumor)
familial

Question 23

peripheral precocious puberty

Answer 23

ovarian cyst, adrenal tumors, CAH

Question 24

adrenarche – pubic hair, axillary hair, acnea, some increased body odor

Answer 24

adrenal tumor

Question 25

Symptoms of estrogen excess – breast development and vaginal bleeding

Answer 25

ovarian cysts or tumors

Question 26

treat central precocious puberty

Answer 26

GnRH analog- Leuprolide

Question 27

boys- pseudoprecocious puberty

Answer 27

peripheral stimulation, GnRH independent, small testes

Question 28

boys- true precocious puberty

Answer 28

central stimulation, GnRH dependent, large testes

Question 29

define delayed puberty in boys and girls

Answer 29

boys 14 no signs, girls 13 no signs

Question 30

primary hypogonadism

Answer 30

absence / malfunction/ destruction of ovarian or testicular tissue

Question 31

central hypogonadism

Answer 31

pituitary or hypothalamic dysfunction (panhypopituitarism, CNS tumor, gonadotropin deficiency)

Question 32

most common cause of delayed puberty in boys

Answer 32

Kleinfelter syndrome

Question 33

labs for primary vs central hypogonadism

Answer 33

primary: LH, FSH elevated central: LH, FSH low

Question 34

treat hypogonadism

Answer 34

sex steroid replacement

Question 35

most common cause of female virilization, pseudohermaphrodite

Answer 35

CAH

Question 36

most frequent cause of ambiguous genitalia in the newborn

Answer 36

CAH

Question 37

labs for CAH

Answer 37

elevated 17 OH, deficiency of 21 hydroxylase, electrolyte imbalances

Question 38

treat CAH

Answer 38

hydrocortisone, mineralcorticoid

Question 39

most common etiology of CAH

Answer 39

deficiency of 21 hydrocylase

Question 40

adrenal insufficiency

Answer 40

uncommon CAH autoimmune destruction (Addisons)

Question 41

adrenal excess

Answer 41

uncommon, Cushings | Exogenous steroids most common cause of cushings in children

Question 42

test for adrenal insufficiency

Answer 42

ACTH stim test

Question 43

treat adrenal insufficiency

Answer 43

replace hydrocortisone, fludrocortisone

Question 44

Truncal adoposity with thin extremities, moon facies, muscle wasting, weakness, easy bruising, purplish striae HTN, osteoporosis, glycosuria, hyperglycemia

Answer 44

Cushing's syndrome

Question 45

test for cushings

Answer 45

urinary cortisol level | dexamethasone suppression test

Question 46

type I DM

Answer 46

insulin dependent, juvenile diabetes or IDDM

Question 47

most common type of DM in children

Answer 47

type I (this is almost not true anymore)

Question 48

what other endocrine system would you check in a kid with type I DM

Answer 48

thyroid (hypothyroid can be associated)

Question 49

treat type I DM

Answer 49

insulin, diet,exercise, stress management, glucose monitoring

Question 50

triad type I DM

Answer 50

polyuria polydipsia polyphagia

Question 51

ancanthosis nigricans

Answer 51

changes in skin related to type II DM

Question 52

type II DM

Answer 52

“Non-insulin dependent” – insulin resistance and insulin insensitivity

Question 53

type II DM has an association with this syndrome

Answer 53

polycystic ovarian syndrome

Question 54

what do children die from in DKA

Answer 54

cerebral edema

Question 55

ketone effect on serum pH

Answer 55

lower (the produce free hydrogen ions)

Question 56

treat DKA

Answer 56

replace fluid insulin replace body salts correct acidosis